Created in 1965, Medicaid provides comprehensive health insurance for tens of millions of Americans who have low incomes or qualifying disabilities. As the overall cost of healthcare has skyrocketed in the United States, federal spending on Medicaid has risen as well, leading President Trump and Congressional Republicans to target the program as a place for significant cuts.

One major avenue for cutting the program is eliminating or sharply reducing the Medicaid expansion under the Affordable Care Act. Medicaid – while operated by the states – is financed by both the federal government and each respective state. The ACA’s expansion sharply increased federal funding if states accepted the additional support so that adults with incomes up to 138% of the federal poverty level (FPL) would qualify for Medicaid coverage (in 2025, this translates to $21,597 for a single person or $44,367 for a family of four). Currently, 40 states plus Washington, D.C. have accepted the expansion while 10 states have not.

Proponents of cutting Medicaid also often support imposing work requirements, with the underlying assumption that people relying on the program need to be pushed to enter the job market. However, this framing is wholly untrue; the vast majority of Medicaid beneficiaries hold jobs or are engaged in  caregiving and school. Cutting Medicaid will simply deny health care to millions of hardworking Americans.

What follows is a collection of key data points, demonstrating the realities of the Medicaid program and who cuts would most harm.

Who is Covered

72.3 million

As of October 2024, 72.3 million Americans are enrolled in Medicaid. This number rises to 79.3 million when including the Children’s Health Insurance Program (CHIP), which similarly provides health insurance to low-income children. Overall, 40.6 million adults and 36.8 million children receive health care coverage through Medicaid/CHIP.

30%

As Medicaid depends on family income, millions of Americans fluctuate in and out of the program. In 2023, around 30% or 100.1 million Americans were enrolled in Medicaid at some point.

>25%

Some states rely on Medicaid more than others. In 2022, seven states had over a quarter of their population enrolled in the program: New Mexico (33.5%), Louisiana (32.4%), New York (28.5%), Kentucky (28.3%), West Virginia (28.2%), Arkansas (27.4%), and California (26.8%).

39.5%

A plurality (39.5%) of Medicaid beneficiaries in 2023 were white, followed by Americans of Hispanic (29.9%), Black (18.5%), multiple race (6.5%), Asian/Native Hawaiian or Pacific Islander (4.7%), and American Indian or Alaska Native (1.0%) identities.

17%

Medicaid provides critical health care coverage for many rural Americans, as 17% of Medicaid enrollees in 2021 lived in rural areas, roughly matching the percent of rural Americans overall. In several states however, the proportion of non-elderly adults covered by Medicaid is much higher: Arizona (35.9%), New York (33.9%), New Mexico (31.6%), Louisiana (30.2%), Kentucky (28.5%), and West Virginia (25.5%).

68%

Medicaid recipients are especially likely to be white in rural areas compared to urban areas, as 68% of rural beneficiaries in 2020 were white compared to just 38% in urban areas. However, white Americans still made up the plurality of beneficiaries in urban areas, followed by Hispanic Americans at 30%.

The Affordable Care Act Medicaid Expansion

21 million

In 2022, 21 million Americans received health coverage directly as a result of the ACA’s Medicaid expansion.

2.72 Times Greater

The ACA’s Medicaid expansion sharply reduced the burden of uncompensated care for hospitals (health care that patients cannot pay for themselves and is not covered by insurance). In 2021, uncompensated care costs were just 2.5% of total hospital operating expenses in Medicaid expansion states, compared to 6.9% in states that did not expand Medicaid (around 2.72 times greater).

19,200

A 2021 analysis published in the The Quarterly Journal of Economics – a peer-reviewed academic journal – estimated that 19,200 Americans lived who otherwise would have died due to living in a state that adopted the Medicaid expansion. Conversely, they calculated that 15,600 Americans died in states that rejected the expansion, and these people would have lived otherwise.

$3.4 billion

Through providing health coverage to Americans who otherwise would lack insurance, Medicaid has significantly reduced the amount of medical debt Americans hold. In just the first two years after its implementation, the ACA’s Medicaid expansion cut back unpaid medical bills sent to debt collectors by $3.4 billion and medical bankruptcies by 50,000.

2.5 Times Greater

Uninsured rates for American Indians and Alaskan Natives are among the highest in the country. The ACA’s Medicaid expansion halved their uninsured rates from 30% in 2013 to 15% in 2022 among non-elderly adults in expansion states. Comparatively, the uninsured rate fell from 30% to only 24% in non-expansion states, meaning that the decline was 2.5 times greater in expansion states.

690,000

By providing coverage and reducing out-of-pocket expenses, the Medicaid expansion also sharply reduced the number of Americans living in poverty. From 2010 to 2016, the Medicaid expansion lifted around 690,000 Americans out of poverty.

Who Would Be Impacted by Medicaid Cuts 

4.3 million

Around 4.3 million people would lose their Medicaid coverage due to living in 12 states with trigger laws that eliminate or reduce Medicaid eligibility if federal funding for the ACA’s Medicaid expansion is cut.

36 million

Up to 36 million Americans could lose their Medicaid coverage as a result of recently suggested proposals to impose work requirements by Congressional Republicans. While a majority of Medicaid beneficiaries do work, past experiences show that bureaucratic red tape and administrative burdens would significantly hurt enrollment, especially given that Americans must re-enroll at least once a year.

92%

While proponents of cutting Medicaid through imposing work requirements often suggest or imply that Americans relying on the program are lazy and need to work, the reality is that most are working in some capacity. Among adults aged 19-64, 92% with Medicaid coverage in 2023 were working full (44%) or part (20%) time or did not work due to caregiving (12%), illness/disability (10%), or school (7%).

2.3%

In July 2023, Georgia – a state that has not adopted the Medicaid expansion from the ACA – began its Pathways to Coverage program which implemented work requirements for low-income adults to enroll in Medicaid. However, only 2.3% or 5,500 of the expected 240,000 people that were potentially eligible for the program actually got coverage by November 2024.

$26 million

Georgia spent over $26 million on its Pathways to Coverage program within its first year, with more than 90% of the costs going towards administration and consulting rather than actual health coverage.

50.4%

While Medicaid/CHIP recipients do earn low incomes, around half of families earned more than the threshold of 138% of the FPL set by the ACA expansion in 2023. 50.4% of individuals with Medicaid/CHIP coverage earned more than 138% of the FPL ($21,597 in income for a single person or $44,367 for a family of four), and 21.9% had family incomes between 200-399% of the FPL (between $31,300-$62,600 [single] and $64,300-$128,600 [family of four]). Many states allow individuals to receive Medicaid at higher income levels than 138% of the FPL if they are children, disabled, or pregnant.

33%

Medicaid also covers people with qualifying disabilities, and 33% of Americans enrolled in the program reported having a disability in 2021. This figure is double the rate of Americans overall who report having a disability.

11%

While a third of Medicaid recipients reported having a disability, only around 11% actually got their Medicaid coverage because of a disability. This reality is a result of the strict definition of disability set forth by the Supplemental Security Income (SSI) Program.

37%

Many Americans with disabilities actively work while receiving coverage, as 37% of adult Medicaid beneficiaries with a disability who are not covered by SSI, Social Security Disability Insurance (SSDI), or Medicare worked in 2023.

7.9%

While advocates of cutting Medicaid point towards its growing and significant contribution to federal spending, Medicaid spending grew 7.9% in 2023 which is less than the growth in both Medicare (8.1%) and private health insurance (11.5%). Total spending – $871.7 billion – was also smaller compared to Medicare ($1.0 trillion) and private health insurance ($1.5 trillion), meaning that Medicaid is the smallest contributor to growing health insurance expenditures.